Secular Therapy: Ending the Dogma of Alcoholics Anonymous

Dr. Caleb W. Lack talks to Conatus News on the dangers of some cult-like Alcoholics Anonymous groups and how secular therapy can help.

Dr. Caleb W. Lack, Ph.D. is a licensed clinical psychologist, an Associate Professor of Psychology at the University of Central Oklahoma, and the Director of the Secular Therapist Project. Dr. Lack is the author or editor of six books (most recently Critical Thinking, Science, & Pseudoscience: Why We Can’t Trust Our Brains with Jacques Rousseau) and more than 45 scientific publications on obsessive-compulsive disorder, Tourette’s Syndrome and tics, technology’s use in therapy, and more. He writes the popular Great Plains Skeptic column on skepticink.com and regularly presents nationally and internationally for professionals and the public. Learn more about him here. Previous sessions can be found here: Session 1, Session 2, Session 3

Scott Douglas Jacobsen: Now, I want to do some systemic comparison between Alcoholics Anonymous and secular therapy. What is the meta-theme, the big sky, that envelopes each practices’ therapy?

Dr. Caleb Lack: The overall theme of Alcoholics Anonymous and other 12-step groups, and this is going to be controversial as they would vehemently argue against this, is that people who have problematic levels of drinking are inherently flawed and bad people who need to rely on something outside of their own abilities in order to improve their lives. AA, and other similar groups, conveniently provide the thing on which you must rely, which is their dogmatic and rigid system of specific acts you must engage in. This is reflected in the ideas they have such as “one drink, one drunk” and the idea that you must abstain from all drinking or you will “fall off the wagon” as well as the insistence of relying on someone else (such as your sponsor or people at the very frequent meetings) to monitor your behavior.

Contrast that idea (that something is wrong with you and will always be, so you need someone else to tell you exactly how to live your life) to the work of evidence-based, secular therapists. In this model, you are taught and practice various tools to use that we know help to achieve particular outcomes. Those tools and skills, when implemented and used regularly, put you back in the driver’s seat of your life, enabling you to cope with the various stressors thrown your way in a healthy manner. My job as a therapist is, as I tell the people I work with, to put myself out of a job. In other words, I’m trying to make sure that you don’t need me any longer, that you have all the skills you need to have a healthy, productive life.

Jacobsen: How does religion become a force for good and evil in each, if at all, in either evaluative case?

Lack: For secular therapy, religion and religious beliefs are aspects of a person’s identity that need to be taken into account, considered, and worked within the larger context of therapy. For example, if someone comes to see me and they are struggling with problematic substance use, I would try and find what support networks they have or can tap into in order to increase their social support. That may be a friend group, a family unit, or something like a church family.

A good, ethical secular therapist would not ignore or discount someone’s religious beliefs, they would find a way to use those to help someone achieve the desired change, if possible. But there would not be any insistence that someone needs to declare a new belief system, or pushing changes onto an existing belief system, with a secular therapist. Instead, the therapist would let the empirical and clinical data guide them in what methods would likely help achieve desired change for the individual.

For secular therapy, religion and religious beliefs are aspects of a person’s identity that need to be taken into account, considered, and worked within the larger context of therapy.

This is pretty different from a system like the 12-step programs, which declare that you must believe in their system, and their way, and that that is the only way that you can be helped. This dogmatism may actually serve as a new belief system that becomes either grafted onto an already existing one or perhaps even supplants it. So it’s not that religion, or religious belief per se, are in any way “good” or “evil” from these viewpoints (or in life in general). Instead, it’s that you have the difference between “we have good evidence to suggest this will work, so let’s try it” compared to “we believe this works, and if you don’t agree it’s because you are a bad person.”

Jacobsen: How do those who come from deeply fundamentalist religious traditions describe their overall experience going through AA and secular therapy, respectively?

Lack: I’d say that depends on if they are still in the hold of that fundamentalist belief system or they have escaped it. For those raised in and still enmeshed in that kind of environment, then the declarations and rigid, controlled system of the 12-step programs familiar and safe. If you’ve been raised in a system that focuses on external controls for your behavior and decisions, then AA and the like could be like putting on a well-worn glove.

The only difference is the specifics of what behaviors you are allowed or forced to do, and what sort of thoughts would be considered proper rather than improper or “sinful.” For someone who has left a fundamentalist tradition, I would say that moving into AA or a similar program would likely cause a huge amount of discomfort, likely activating negative emotions and thoughts because of the similarities.

On the other hand, someone embedded in a fundamentalist system still would likely be a bit taken aback by some of the concepts used in say, cognitive-behavioral therapy. Ideas such as how we can actively evaluate and challenge our thoughts rather than just accept them as true often lead to questioning other things as well. If you’ve been taught to not question authority or “revealed knowledge,” this can be a big shift in your worldview, and could potentially lead to conflict within the system you are. For those who have left such a system, there really shouldn’t be any inherent conflict, although they may still have some of those beliefs and schemas (such as, “You cannot question authority” or “There is only one true way to live”) that may need to be processed during treatment.

Jacobsen: If you removed the higher power portions from AA, as I believe you indicated before, would you be left with many aspects of secular therapy?

Lack: Taking out the reliance on a higher power from AA would still leave a highly rigid set of rules and guidelines. This is a problem for several reasons. Our secular alternatives to AA – programs like SMART Recovery, LIfeRing, or S.O.S. – focus on providing that new, healthier community via peer support while learning effective coping skills that place the emphasis on increasing your self-efficacy. These are strict rules that you “must” do, but instead flexible skills that allow you to better cope with obstacles that come up, regardless of what they are. Being able to roll with the punches of life in this way typically leaves people more able to effectively navigate any difficulties they face. These programs also emphasize that recovering from addiction to something is a process that will not always go in a positive upward line, and so you need to accept any setbacks for what they are – temporary and an opportunity to push forward using your newly learned skills.